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L-Leucine prevents ammonia-induced changes in glutamate receptors in the brain and in visual evoked potentials in the rabbit.

The effect of L-leucine on glutamate receptors in the brain and on visual evoked potentials was studied in hyperammonemic rabbits. Hyperammonemia was induced by the iv infusion of 2.1 mmol NH4Cl/h over 3 hr. Hyperammonemia was followed by a 116% increase in the specific binding of 3H-glutamate to synaptic membranes prepared from the hippocampus. This increase was due to both an increase in the affinity and in the density of the glutamate receptor. The simultaneous infusion of L-leucine (6.7 mmol/hr) completely prevented the ammonia-induced increase in the specific glutamate binding, whereas L-valine and D-leucine had no effect. Hyperammonemia was also associated with typical, reproducible, and reversible changes in visual evoked potentials. The amplitudes of the first negative and the second positive peak decreased, whereas the latencies of these peaks remained unchanged. The simultaneous infusion of L-leucine completely prevented these changes. These findings indicate (1) that L-leucine prevents ammonia-induced changes in the glutamatergic excitatory neurotransmitter system and (2) that pharmacologic doses of L-leucine modulate the effects of hyperammonemia on central neurotransmission as assessed by visual evoked potentials. A causal relationship between the effects of L-leucine on ammonia-induced changes in glutamate receptors and in visual evoked potentials cannot be inferred with confidence. These findings provide a potential alternative explanation for the apparent beneficial effects of infusions of branched-chain amino acids on hepatic encephalography in patients with chronic liver disease.

Ammonia↗

Patency of ventriculo-atrial shunt determined radiologically.

A radiologic method for assessment of the patency of ventriculo-atrial shunts is described together with a safe technique for gas encephalography of patients with ventriculo-atrial shunt. Despite discontinuity the shunting system may be functioning.

Cerebrospinal Fluid Shunts↗

Computer tomography for diagnosis of intracranial tumours compared with other neuroradiologic procedures.

The diagnostic effectiveness of computer tomography has been assessed in a series of 361 patients with the primary clinical problem of a possible intracranial neoplasm. Of these patients, 171 were shown to have a tumour, confirmed at microscopy in 115 instances. Computer tomography was compared with other established neuroradiologic procedures, such as encephalography, angiography and isotope scanning, all of which were frequently used in this series of patients.

Brain Neoplasms↗

Computer tomography compared with spectrophotometry of cerebrospinal fluid in cerebrovascular diseases.

Eighty patients with cerebrovascular diseases were examined by computer tomography and spectrophotometry of CSF, most cases being followed by repeat examinations. Specific diagnoses were obtained in 76 per cent of the cases at tomography and in 95 per cent at spectrophotometry, generally at one examination. In cases examined angiographically or by isotope encephalography, the corresponding figures were 60 and 58 per cent. Twenty patients with confirmed haemorrhage or infarction examined only at tomography further indicated the high diagnostic significance of this method. The combination of tomography and spectrophotometry, being complementary to each other, obviously means a break-through in the diagnosis of cerebrovascular diseases, which is a prerequisite for a more rational therapy of these common and frequently disabling disorders.

Brain↗

Ischemic chiasmal syndrome.

Twenty-two patients with ischemic chiasmal syndrome (ICS) have been examined by means of magnification angiography and polytomographic encephalography. The causes of ICS may be divided into 5 categories: (1) mechanical compression of the chiasm by ectatic redundant anterior cerebral arteries, (2) atherosclerotic vascular occlusions, (3) optochiasmal arachnoidal fibrosis, (4) various forms of arteritis especially giant cell (cranial) arteritis, and (5) post-partum pituitary necrosis associated with ICS. The most common cause of ICS appears to be optochiasmal arachnoiditis which occasionally developed some time after a craniotomy and radiation therapy for pituitary or other juxta-sellar tumors; similar fibrotic change may develop following steroid treatment of granulomatous lesions.

Adult↗

Quantitative analysis of the pituitary fossa and gland in Cushing's disease.

With tomography and encephalography of 78 cases with primary Cushing's disease, changes in the appearance of the pituitary gland and fossa have been demonstrated in greater numbers than previously reported. One or more direct or indirect signs of enlargement of the pituitary gland either by hyperplasia, microadenoma, or adenoma occurred in 60 per cent. Most of these cases were unproved as to cell type because they were given proton beam therapy. There were more cases of pituitary enlargement in those with adrenalectomy in comparison to non-adrenalectomy cases and in those with pigmentation in comparison to non-pigmented cases. The high incidence of pituitary gland enlargement in the different phases of this disease supports the importance of this gland in the pathogenesis of primary Cushing's disease. Limitation in correlation of the pituitary fossa to size of the pituitary gland when the latter enlarges only slightly has been discussed.

Adenoma, Chromophobe↗

Developmental defects of the cerebellum. A radiologic and anatomic investigation.

A classification of cerebellar malformations is proposed, based on more than fifty cases with varying degrees of abnormality, where comparative anatomic and radiologic analysis was carried out. The anatomic information was collected at surgery or autopsy and the radiologic evidence was derived from encephalography or ventriculography and vertebral angiography. The malformations were classified in four groups in order of gravity, with regard to the morphologic and etiologic features: (1) total or sub-total agenesia of the cerebellar structures (vermis and hemispheres); (2) almost complete agenesia of the vermis associated with the Dandy-Walker malformation; (3) almost complete agenesia of the vermis without the Dandy-Walker malformation; (4) partial defects of the vermis, which could be separated into four subdivisions.

Arachnoid↗

Cisternal abnormalities produced by clinical tumours in the posterior cranial fossa. I. Cerebellar tumours.

A detailed analysis of the deformities of the subarachnoid cisterns was carried out in a clinical material of 65 cases with cerebellar tumours examined by encephalography. The distortion of the cisterns was related to 8 different tumour positions, and the results compared with those from a previous experimental investigation. Typical cisternal distortions for cerebellar tumours are listed, constituting a basis for a general analysis of the cisternal abnormalities demonstrated by whatever means of neuroradiologic procedure employed: pneumography, computer tomography or cisternography with positive contrast medium.

Adolescent↗

Computed tomography in the evaluation of the supraclinoid arteries in suprasellar pituitary gland tumors.

The demonstration of the supraclinoid arteries at CT in 38 patients with suprasellar lesions was evaluated. The anterior cerebral artery was visible in 8 per cent, the other supraclinoid arteries in about 80 per cent. In one patient cerebral angiography revealed a giant aneurysm which was erroneously considered as a suprasellar neoplasm at CT and encephalography. The demonstration of the supraclinoid arteries was often inadequate in large suprasellar tumors. Therefore, cerebral angiography is still necessary preoperatively in suprasellar pituitary lesions-at least at the state of technology represented by the Delta 25 Head Scanner.

Adenoma↗

Clinical trial of iohexol in lumbar myelography.

Iohexol containing 180 mg I/ml was used in 20 patients for lumbar myelography. By using an adequate volume up to a maximum of 15 ml, satisfactory films were obtained in all cases. Minor or moderate adverse effects occurred in 4 patients. There were no changes in vital signs or neurologic examination related to the examinations. No patient had difficulty with concentration, personality changes or seizures. Later encephalographies performed in all patients before and during 24 h after the iohexol injections, showed no seizure or abnormal activity or any significant change. Repeated lumbar puncture was performed in 9 patients 24 h after the injection of iohexol. One of these, a patient with symptoms due to disc prolapse, whose CSF was abnormal before the myelography, had a slightly increased cellular response. There was no significant change in any of the other patients. Iohexol is a very satisfactory contrast medium for myelography and compared favorably with other non-ionic contrast media.

Adult↗

Serial CT scanning in childhood tuberculous meningitis: prognostic features in 198 cases.

Serial cranial computed tomographic (CT) scanning and intracranial pressure monitoring were performed on 198 children with stage II and III tuberculous meningitis. The aims of the study were to document the course of tuberculous hydrocephalus during medical and surgical treatment, as well as the prognostic significance of parenchymal changes in the brain as demonstrated by CT. Lumbar cerebrospinal fluid pressure was monitored continuously for a 1-hour period in all patients on admission and at weekly intervals in patients with communicating hydrocephalus for the 1st month of treatment. Cranial CT scanning was done on admission and repeated in survivors after 1 month and again after 6 months of antituberculous therapy. The raised intracranial pressure of 112 children with communicating hydrocephalus, as demonstrated by air-encephalography, was treated medically (with daily acetazolamide and furosemide) for 1 month. Thirty-one children with noncommunicating hydrocephalus were referred for immediate ventriculoperitoneal shunting. No significant difference was found in the eventual ventricular size or clinical outcome between the two treatment groups. Lumbar cerebrospinal fluid pressure changes in the children with communicating hydrocephalus closely followed changes in the degree of hydrocephalus during the course of treatment. The main cause of permanent neurologic disability was basal ganglia infarction, which occurred unilaterally in 21% and bilaterally in 10% of patients on admission and developed in a further 22% of children during treatment. A prominent subarachnoid space, which was seen on the CT scan of 36% of patients after the 1st month of treatment and which reverted to normal, probably relates to the poor nutritional state of these patients on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Antitubercular Agents↗

Two magneto-encephalographic epileptic foci did not coincide with the electrocorticographic ictal onset zone in a patient with temporal lobe epilepsy.

To evaluate the usefulness and limitations of magneto-encephalography (MEG) for epilepsy surgery, we compared 'interictal' epileptic spike fields on MEG with ictal electrocorticography (ECoG) using invasive chronic subdural electrodes in a patient with intractable medial temporal lobe epilepsy (MTLE) associated with vitamin K deficiency intracerebral hemorrhage. A 19-year-old male with an 8-year history of refractory complex partial seizures, secondarily generalized, and right hemispheric atrophy and porencephaly in the right frontal lobe on MRI, was studied with MEG to define the interictal paroxysmal sources based on the single-dipole model. This was followed by invasive ECoG monitoring to delineate the epileptogenic zone. MEG demonstrated two paroxysmal foci, one each on the right lateral temporal and frontal lobes. Ictal ECoG recordings revealed an ictal onset zone on the right medial temporal lobe, which was different from that defined by MEG. Anterior temporal lobectomy with hippocampectomy was performed and the patient has been seizure free for two years. Our results indicate that interictal MEG does not always define the epileptogenic zone in patients with MTLE.

Adult↗

Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler--a systematic review of the literature.

BACKGROUND: Transcranial Doppler Ultrasound (TCD) is a sensitive, real time tool for monitoring cerebral blood flow velocity (CBFV). This technique is fast, accurate, reproducible and noninvasive. In the setting of congenital heart surgery, TCD finds application in the evaluation of cerebral blood flow variations during cardiopulmonary bypass (CPB). METHODOLOGY: We performed a search on human studies published on the MEDLINE using the keyword "trans cranial Doppler" crossed with "pediatric cardiac surgery" AND "cardio pulmonary by pass", OR deep hypothermic cardiac arrest", OR "neurological monitoring". DISCUSSION: Current scientific evidence suggests a good correlation between changes in cbral blood flow and mean cerebral artery (MCA) blood flow velocity. The introduction of Doppler technology has allowed an accurate monitorization of cerebral blood flow (CBF) during circulatory arrest and low-flow CPB. TCD has also been utilized in detecting cerebral emboli, improper cannulation or cross clamping of aortic arch vessels. Limitations of TCD routine utilization are represented by the need of a learning curve and some experience by the operators, as well as the need of implementing CBF informations with, for example, data on brain tissue oxygen delivery and consumption. CONCLUSION: In this light, TCD plays an essential role in multimodal neurological monitorization during CPB (Near Infrared Spectroscopy, TCD, processed electro encephalography) that, according to recent studies, can help to significantly improve neurological outcome after cardiac surgery in neonates and pediatric patients.

Aorta, Thoracic↗

Neuropsychiatric lupus favourable response to low dose i.v. cyclophosphamide and prednisolone (pilot study).

Sixty SLE patients with only primary neuropsychiatric manifestations (NP-SLE), (54 female and six male; mean age 44.5) were compared consecutively. Forty-six of the patients (78.3%) were presented with a combination of neuropsychiatric symptoms. Except for the standard immunoserological test, all patients underwent clinical, neurological and psychiatric examination, electrophysiological tests [EEG (electro-encephalography involves recording and analysis of electrical signals generated by the brain), EP (the evoked potentials method involves analysis of a series of electrical signals generated in parts of the nervous system following stimulation of sense organs and peripheral nerves) and EMNG (electro-myo-neography is a method of measurement of electrical activity arising from muscle fibers and peripheral nerves)]. This method presents a valuable tool for assessment of functional state of peripheral nervous systems and muscles)), and neuroimaging (MRI of the brain). Thirty-seven out of 60 patients with NP-SLE (group I) were treated with a low dose of i.v. cyclophosphamide (200-400 mg per month). The average daily oral dose of prednisone in these patients was 20.5 mg. Group II consisted of 23 patients treated with pridnisone (mean dose 20.5 per day) only or with antimalarials. Patients in the first group showed a considerable clinical and electrophysiological improvement of cerebral function, while there was only a slight or no improvement in the second group. The difference between groups was statistically significant.

Adolescent↗

Prolonged and monosymptomatic dysphasic status epilepticus.

Dysphasic seizures are an infrequent form of epilepsy, and their serial appearance as a partial status epilepticus is quite exceptional. The young patient reported here had a partial dysphasic status epilepticus of 3 weeks' duration without other temporal lobe seizures. Simultaneous serial electroencephalograms, tape recordings of the seizures, and repeated neuropsychologic ictal examinations permitted studies of increased impairment of neuropsychologic function on testing and the appearance of new irritative discharges on encephalography.

Adolescent↗

Stereotactic implantation of deep brain electrodes using computed tomography.

The selection of intracranial targets for stereotactic functional neurosurgical procedures traditionally has relied on information derived from pooled brain atlases and supplemented by contrast encephalographic or angiographic data from the individual patient. The integration of stereotaxy with computed tomography (CT) has permitted direct identification of intracranial targets based on multiplanar reformatted CT images from each individual patient. Four patients underwent the CT stereotactic implantation of a single deep brain electrode for the control of chronic pain (two cases) or of multiple depth electrodes for long term electroencephalographic recordings in the management of seizure disorders (two cases). In all patients, accurate and precise electrode placement was achieved from CT images alone. The use of CT permitted detailed anatomical stereotactic study of each patient's brain, the preplotting of electrode trajectories before probe insertion, and the rapid confirmation of precise electrode placement. Intraoperative contrast encephalography was not necessary. Functional neurosurgery was performed successfully and advantageously using CT stereotactic technique alone.

Adult↗